The majority of women who stop smoking during pregnancy resume postpartum. Previous relapse prevention programs have had disappointing results. The proposed intervention addresses the limitations of previous programs by assessing women on multiple risk dimensions, creating a risk profile, triaging women to an appropriate level of intervention intensity, matching the intervention to women's risks, continuing the intervention for 10 months postpartum, and referring women to community resources. In this study we will: a) evaluate the efficacy of our intervention to delay or prevent women's return to smoking postpartum, b) explore the relative contribution of risk factors (dependence, readiness, self efficacy, sensory aversion, stopped for the fetus, partner smoking, depression, and weight concerns) to postpartum smoking, c) describe the natural course of change of risk factors, d) describe the context in which abstinence or resumption occurs and, e) estimate the costs of intervention delivery. A two arm randomized trial will be conducted. The sample will be 450 pregnant women age 18 or older from two North Carolina sites who stopped smoking during pregnancy. Women will be screened abut their risk factors between 28 and 32 weeks of pregnancy and triaged to one of four levels of stepped care that includes one in person counseling session and at least one telephone session during pregnancy and from 7 12 telephone sessions over 10 months postpartum. Concepts from the self determination theory, social cognitive theory, transtheoretical model, and relapse prevention theory that are relevant for the transition from pregnancy to postpartum will guide the intervention strategies that include motivational interviewing, enhancing self efficacy, anticipating and planning for high risk parenting and social situations, and the use of pharmacotherapies. Women randomized to the control arm will receive a relapse prevention booklet and usual care. Quantitative data on smoking status and risk variables will be collected at baseline, 6 weeks and 6 and 12 month postpartum and qualitative data will be collected at 12 months. Survival curve analysis will be used to determine the primary outcome of time to first smoking resumption. An efficacious resumption prevention intervention will move us toward the Healthy People 2010 tobacco goals for women. PUBLIC HEALTH RELEVANCE: Pregnancy is a time when many women quit smoking;however, many return to smoking after the baby is born. Programs developed to prevent this return to smoking have not been very effective. We are proposing to test a program whose intensity is matched to women's characteristics to help delay or prevent return to smoking. Our overall goal is to help women who quit smoking during pregnancy become lifetime nonsmokers.